Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors
Giorgia De BerardisFabio PellegriniMonica FranciosiMaurizio BelfiglioBarbara Di NardoSheldon GreenfieldSherrie H. KaplanMaria Chiara RossiMichele SaccoGianni TognoniUmberto ValentiniAntonio Nicolucci
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No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Apr 2003Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors GIORGIA De BERARDIS, FABIO PELLEGRINI, MONICA FRANCIOSI, MAURIZIO BELFIGLIO, BARBARA DI NARDO, SHELDON GREENFIELD, SHERRIE H. KAPLAN, MARIA C.E. ROSSI, MICHELE SACCO, GIANNI TOGNONI, MIRIAM VALENTINI, ANTONIO NICOLUCCI, and FOR THE QUALITY OF CARE AND OUTCOMES IN TYPE 2 DIABETES STUDY GROUP* GIORGIA De BERARDISGIORGIA De BERARDIS , FABIO PELLEGRINIFABIO PELLEGRINI , MONICA FRANCIOSIMONICA FRANCIOSI , MAURIZIO BELFIGLIOMAURIZIO BELFIGLIO , BARBARA DI NARDOBARBARA DI NARDO , SHELDON GREENFIELDSHELDON GREENFIELD , SHERRIE H. KAPLANSHERRIE H. KAPLAN , MARIA C.E. ROSSIMARIA C.E. ROSSI , MICHELE SACCOMICHELE SACCO , GIANNI TOGNONIGIANNI TOGNONI , MIRIAM VALENTINIMIRIAM VALENTINI , ANTONIO NICOLUCCIANTONIO NICOLUCCI , and FOR THE QUALITY OF CARE AND OUTCOMES IN TYPE 2 DIABETES STUDY GROUP* View All Author Informationhttps://doi.org/10.1097/01.ju.0000053241.06172.95AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We estimated the prevalence of erectile dysfunction in patients with type 2 diabetes and identified subgroups of patients in which the interaction among clinical, psychological and sociodemographic characteristics determined an increased likelihood of erectile dysfunction. Materials and Methods: The presence of erectile dysfunction was based on patient self-reporting. Clinical information was collected by participating physicians. The severity of depressive symptoms was investigated using the Center for Epidemiological Studies Depression scale. To evaluate interactions among the variables investigated and identify distinct, homogeneous subgroups of patients with different odds ratios for erectile dysfunction a tree growing technique was used. Results: In the 1,460 patients studied the prevalence of severe and mild-moderate erectile dysfunction was 34% and 24%, respectively. While severe erectile dysfunction was mainly related to the severity of diabetes, mild-moderate dysfunction was independent of clinical variables and only associated with the severity of depressive symptoms. The tree growing technique led to the identification of 6 classes characterized by a marked difference in the prevalence of severe erectile dysfunction of between 19% and 65%. Patients on diet alone showed the lowest prevalence of erectile dysfunction and were considered the reference category, while patients treated with insulin who had neuropathy represented the subgroup with the highest likelihood of erectile dysfunction (OR = 7.2, 95% CI 3.9 to 13.2). In patients treated with oral agents the odds ratio for erectile dysfunction was 2.7 (95% CI 1.8 to 3.9) for those with severe depressive symptoms and 1.9 (95% CI 1.3 to 2.7) for current/former smokers with low depressive symptoms. Patient age, retinopathy and cardiac-cerebrovascular disease were globally predictive variables associated with an increased likelihood of erectile dysfunction. Conclusions: Our data illustrate the interplay of clinical and psychological factors in determining the risk of erectile dysfunction in type 2 diabetes and can help identify those for whom much greater attention is needed to detect erectile problems. 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Google Scholar From the Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy, and Tufts University School of Medicine, Boston, Massachusetts© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDe Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, Kaplan S, Rossi M, Sacco M, Tognoni G, Valentini M and Nicolucci A (2018) Clinical and Psychological Predictors of Incidence of Self-Reported Erectile Dysfunction in Patients With Type 2 DiabetesJournal of Urology, VOL. 177, NO. 1, (252-257), Online publication date: 1-Jan-2007. Volume 169Issue 4April 2003Page: 1422-1428 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordspenisdiabetes mellitusquestionnairesdepressionimpotenceMetricsAuthor Information GIORGIA De BERARDIS More articles by this author FABIO PELLEGRINI More articles by this author MONICA FRANCIOSI More articles by this author MAURIZIO BELFIGLIO More articles by this author BARBARA DI NARDO More articles by this author SHELDON GREENFIELD More articles by this author SHERRIE H. KAPLAN More articles by this author MARIA C.E. ROSSI More articles by this author MICHELE SACCO More articles by this author GIANNI TOGNONI More articles by this author MIRIAM VALENTINI More articles by this author ANTONIO NICOLUCCI More articles by this author FOR THE QUALITY OF CARE AND OUTCOMES IN TYPE 2 DIABETES STUDY GROUP* Scientific committee: Vittorio Caimi, Fabio Capani, Andrea Corsi, Roberto Della Vedova, Massimo Massi Benedetti, Antonio Nicolucci, Claudio Taboga, Massimo Tombesi and Giacomo Vespasiani. Investigators: diabetologists R. Rinaldi, E. Papini, A. Pagano and L. Petrucci, Albano Laziale, RM; P. Maresca and F. Malvicino, Alessandria; A. Corsi, E. Torre, P. Ponzani and F. Menozzi, Arenzano, GE; S. Baracchi and M. Iorini, Asola, MN; L. Gentile, Asti; P. Di Berardino, Atri, TE; P. Dell'Aversana, Aversa, CE; T. Savino, Bari; G. Amore, Bassano Del Grappa, VI; F. Zerella, Benevento; F. Travaglino and G. Morone, Biella; N. Pinna, Borgosesia, VC; M. A. Poli, Bovolone, VR; A. M. Sanna, L. Carboni, F. Farci, P. 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Risk factors of erectile dysfunction Pathophysiology of ED in diabetes mellitus Erectile dysfunction: A first sign of cardiovascular disease? The artery size hypothesis: A macrovascular link between ED and CAD Other causes of erectile dysfunction Differentiation between organic and psychogenic erectile dysfunction Treatment of erectile dysfunction in diabetic patients Conclusions References
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Men with erectile dysfunction often have concurrent medical conditions. Conversely, men with these conditions may also have underlying erectile dysfunction. The prevalence of unrecognized erectile dysfunction in men with comorbidities commonly associated with erectile dysfunction was determined in men invited to participate in a double-blind, randomized, placebo-controlled trial of sildenafil citrate.Men ≥30 years old presenting with ≥1 erectile dysfunction risk factor (controlled hypertension, hypercholesterolemia, smoking, metabolic syndrome, stable coronary artery disease, diabetes, depression, lower urinary tract symptoms, obesity [body mass index ≥30 kg/m2] or waist circumference ≥40 inches), and not previously diagnosed with erectile dysfunction were evaluated. The screening question, "Do you have erectile dysfunction?," with responses of "no," "yes," and "unsure," and the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) were administered.Of 1084 men screened, 1053 answered the screening question and also had IIEF-EF scores. IIEF-EF scores indicating erectile dysfunction occurred in 71% (744/1053), of whom 54% (399/744) had moderate or severe erectile dysfunction. Of 139 answering "yes," 526 answering "unsure," and 388 answering "no," 96%, 90%, and 36%, respectively, had some degree of erectile dysfunction. The mean±SD (range) number of risk factors was 2.9 ± 1.7 (3-8) in the "yes" group, 3.2 ± 1.7 (3-9) in the "unsure" group, and 2.6 ± 1.5 (2-8) in the "no" group.Although awareness of having erectile dysfunction was low, most men with risk factors had IIEF-EF scores indicating erectile dysfunction. Erectile dysfunction should be suspected and assessed in men with risk factors, regardless of their apparent level of awareness of erectile dysfunction.ClinicalTrials.gov Identifier NCT00343200.
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Diabetes and erectile dysfunction often go hand in hand. Different types of medications and therapies are required for the effective management of erectile dysfunction. Treatment options for erectile dysfunction in diabetes patients are discussed in this article. Effectiveness and limitation of the medications have been clarified here and, finally, side effects and contraindication of different medications for erectile dysfunction management have also been reflected. Erectile dysfunction treatment in diabetes patients not only depends on selecting proper medication, but glycaemic control also; therefore, both diabetes and ED are required to treat simultaneously.
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CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.
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This chapter contains sections titled: Introduction Prevalence of erectile dysfunction diabetes Pathophysiology of erectile dysfunction in diabetes Testosterone, metabolic syndrome, insulin resistance and type 2 diabetes Impact of erectile dysfunction on the patient Clinical features Assessment and investigation of erectile dysfunction in diabetes The management of erectile dysfunction in diabetes Treatment of erectile dysfunction References
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Diabetes mellitus is a chronic degenerative disease characterized by an increase in normal blood sugar levels which causes high levels of glucosuria. Measuring HbA1c is an accurate way to determine high blood sugar levels over the last two to three months. Erectile dysfunction is the inability to have or maintain an erection for at least the last 6 months, up to the incidence of erectile dysfunction based on the IIEF-5 score. The prevalence In Indonesia, Riskesdas data highlights 10 million diabetes patients and 17.9 million individuals at risk of developing the condition. This means that Indonesia has quite high diabetes mellitus. Meanwhile, the prevalence research indicates a prevalence of approximately 4% for moderate to severe erectile dysfunction as measured by the Sexual Health Inventory for Men (SHIM). Therefore, controlling diabetes mellitus is the key to preventing ED.
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CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.
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This chapter contains section titled: Introduction Prevalence of erectile dysfunction Pathophysiology of erectile dysfunction in diabetes The aetiology of erectile dysfunction in diabetes mellitus Assessment and investigation of erectile dysfunction in diabetes General advice Treatment options The practical management of erectile dysfunction in a diabetic clinic Organizing an impotence clinic Screening for erectile dysfunction Summary References
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